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Cost-effectiveness of interventions to control cardiovascular diseases and diabetes mellitus in South Asia: a systematic review

Singh, Kavita; Chandrasekaran, Ambalam; Bhaumik, Soumyadeep; Chattopadhyay, Kaushik; Gamage, Anuji Upekshika; Silva, Padmal De; Roy, Ambuj; Prabhakaran, Dorairaj; Tandon, Nikhil

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Authors

Kavita Singh

Ambalam Chandrasekaran

Soumyadeep Bhaumik

Anuji Upekshika Gamage

Padmal De Silva

Ambuj Roy

Dorairaj Prabhakaran

Nikhil Tandon



Abstract

OBJECTIVES: More than 80% of cardiovascular diseases (CVD) and diabetes mellitus (DM) burden now lies in low and middle-income countries. Hence, there is an urgent need to identify and implement the most cost-effective interventions, particularly in the resource-constraint South Asian settings. Thus, we aimed to systematically review the cost-effectiveness of individual-level, group-level and population-level interventions to control CVD and DM in South Asia.

METHODS: We searched 14 electronic databases up to August 2016. The search strategy consisted of terms related to 'economic evaluation', 'CVD', 'DM' and 'South Asia'. Per protocol two reviewers assessed the eligibility and methodological quality of studies using standard checklists, and extracted incremental cost-effectiveness ratios of interventions.

RESULTS: Of the 2949 identified studies, 42 met full inclusion criteria. Critical appraisal of studies revealed 15 excellent, 18 good and 9 poor quality studies. Most studies were from India (n=37), followed by Bangladesh (n=3), Pakistan (n=2) and Bhutan (n=1). The economic evaluations were based on observational studies (n=9), randomised trials (n=12) and decision models (n=21). Together, these studies evaluated 301 policy or clinical interventions or combination of both. We found a large number of interventions were cost-effective aimed at primordial prevention (tobacco taxation, salt reduction legislation, food labelling and food advertising regulation), and primary and secondary prevention (multidrug therapy for CVD in high-risk group, lifestyle modification and metformin treatment for diabetes prevention, and screening for diabetes complications every 2-5 years). Significant heterogeneity in analytical framework and outcome measures used in these studies restricted meta-analysis and direct ranking of the interventions by their degree of cost-effectiveness.

CONCLUSIONS: The cost-effectiveness evidence for CVD and DM interventions in South Asia is growing, but most evidence is from India and limited to decision modelled outcomes. There is an urgent need for formal health technology assessment and policy evaluations in South Asia using local research data. PROSPERO REGISTRATION NUMBER: CRD42013006479.

Citation

Singh, K., Chandrasekaran, A., Bhaumik, S., Chattopadhyay, K., Gamage, A. U., Silva, P. D., …Tandon, N. (2018). Cost-effectiveness of interventions to control cardiovascular diseases and diabetes mellitus in South Asia: a systematic review. BMJ Open, 8(4), Article e017809. https://doi.org/10.1136/bmjopen-2017-017809

Journal Article Type Article
Acceptance Date Feb 16, 2018
Publication Date Apr 3, 2018
Deposit Date Apr 9, 2018
Publicly Available Date Mar 29, 2024
Journal BMJ Open
Electronic ISSN 2044-6055
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 8
Issue 4
Article Number e017809
DOI https://doi.org/10.1136/bmjopen-2017-017809
Keywords South Asia; cardiovascular diseases; cost-effectiveness; analysis; diabetes mellitus; economic evaluation; systematic review
Public URL https://nottingham-repository.worktribe.com/output/923511
Publisher URL http://bmjopen.bmj.com/content/8/4/e017809

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